The connection between social factors and PTSD

^{Dr Tiago Zortea is a clinical psychologist and has recently obtained a PhD in Psychological Medicine at the University of Glasgow within the Suicidal Behaviour Research Laboratory. He is a co-founder of netECR, the International Network of Early Career Researchers in Suicide and Self-harm, and his work focuses mainly on understanding suicidal behaviour and promoting suicide prevention internationally.}

Disadvantaged communities

It has been consistently evidenced that disadvantaged communities and persons are particularly vulnerable to both being exposed to traumatic stressors, and to developing PTSD and other psychopathology.

These communities include those affected by poverty, migration, homelessness, disabilities, political oppression, torture, natural disasters and stigma and discrimination.

A range of factors has been proposed to account for those trends, including chronic and cumulative stress, victimisation, structural violence, intergroup conflict, along cultural beliefs and practices.

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Culture, ethnicity, and PTSD

Culture and ethnicity represent particularly interesting categories with regards to PTSD risk. In some cases, individuals belonging to ethno-racial minority groups have been reported to experience higher rates of PTSD than the general population while, in others-lower rates of PTSD.

For example, although Latino and African American groups in the USA have been shown by multiple studies to be more likely to experience PTSD than European Americans, over generalisations should be avoided given the diversity within different cultural and ethnic groups (Ford et al., 2015).

Increased exposure to stressful life events

Explanations for those observations vary widely and include considerations of increased exposure to stressful and traumatic life events such as migration, discrimination, violence and poverty.

This history of adverse life events are often exacerbated by those groups’ limited access to family, community and cultural resources as a result of displacement, poverty, and other adverse factors.

The preservation of ties to one’s family, culture and community has been proposed to be a vital protective factor against PTSD and poor mental health more broadly.

For instance, individuals of Asian or African descent have been shown to be less likely than those of other ethnocultural groups to develop PTSD (Ford et al., 2015).

One explanation for this may be the role of cultural beliefs, traditions and practices. Examples include religious involvement, strong kinship bonds, respect for elders, communal orientation and holistic thinking (Bell, 2011).

Intersectionality

When assessing trauma and PTSD risk, categories of difference that may be applicable to individuals, such as ethnicity, sexual orientation, age and socio-economic status, should not be considered in isolation.

Such categories of difference often overlap and interact to create unique experiences of risk and disadvantage.

Intersectionality is a theory that is based on the idea that an individual may be more vulnerable to being subjected to negative social attitudes and practices if they possess multiple, overlapping characteristics of difference.

^{A banner is held up that reads “love is love”. Source: Pexels.com}

Individuals with ‘multiple vulnerability status’ may be more prone to acute and chronic stressors in society. Some examples are an LGBTQI+ individual from an ethnic minority group, an adolescent African American male in the United States, a mother with a physical disability facing homelessness, and others.

All those marginalised identities may be associated with distinct sets of risk factors predisposing the individual to poorer mental health and access to resources.

Some authors have proposed the term ‘intersectional trauma’ to explore how issues related to gender, sexuality, class and race create layers of inequalities that shape the trauma experience (Baird et al., 2019).

Poverty and PTSD

Poverty is another socio-economic factor consistently linked to increased PTSD risk. In its broadest sense, ‘poverty’ encapsulates not only one’s restricted access to housing, healthcare, social participation, employment and education, but also one’s possible exposure to gang violence, drugs, high crime, underfunded institutions and other stressors (Ford et al., 2015).

The exposure to violence and the effects of other chronic stressors such as social disaffiliation and income insecurity have been proposed as potential mechanisms explaining the poorer mental health outcomes observed in impoverished populations.

^{A woman sitting outside a row of houses. Source: Pexels.com}

Homelessness and PTSD

Homelessness is an example of severe poverty compounded by housing shortages, unresponsive welfare systems, poor social support and adverse life experiences.

Individuals with lived experience of homelessness tend to report a considerably higher incidence of traumatic life events and PTSD symptoms than the general population.

For example, a study with low-income homeless women by Frisman and colleagues (2008) demonstrated a rate of 91% for experienced psychologically traumatic events in a lifetime, and about 30% for PTSD symptoms in a lifetime.

Based on the information presented above, make some personal notes on the implications for trauma history assessment and PTSD diagnosis and recovery.

References

^{Baird, S. L., Alaggia, R., & Jenney, A. (2019). “Like opening up old wounds”: Conceptualizing intersectional trauma among survivors of intimate partner violence. Journal of Interpersonal Violence. doi:10.1177/0886260519848788<.sup>}

^{Bell, C. (2011). Trauma, culture, and resiliency. In S. Southwick, B. Litz, D. Charney, & M. Friedman (Eds.), Resilience and Mental Health: Challenges Across the Lifespan (pp. 176-188). Cambridge: Cambridge University Press. doi:10.1017/CBO9780511994791.014}

^{Ford, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). Posttraumatic stress disorder: Scientific and professional dimensions. Academic press.}

^{Frisman, L., Ford, J., Lin, H., Mallon, S., & Chang, R. (2008). Outcomes of trauma treatment using the TARGET model. Journal of Groups in Addiction & Recovery: Special Issue: General Approaches to Groups for Co-Occurring Disorders, 3(3-4), 285-303. doi:10.1080/15560350802424910}